Hi,

I have symptoms of itching on joints and silvery patches on my body. I have consult the doctor and he give some tablets. again i have the problems. Can u tell me the treatment methods. the doctor wrote the prescription sheet as PSORIASIS P.D

Currently there is no cure for psoriasis. However, many types of treatment are available, including products applied to the skin, phototherapy, and oral medications, that can keep psoriasis under control. most cases are mild and can be treated with skin products. in some cases, psoriasis can be hard to treat if it is severe and widespread. most psoriasis returns, even mild forms.

Initial treatment

Treatment for mild psoriasis, characterized by a few isolated raised patches, begins with skin care, which includes keeping your skin moist and lubricated. Basic treatment approaches often involve combinations of therapies and products that can usually be purchased without a prescription, including:

* Creams, ointments, and lotions, to lubricate the skin.
* Shampoos, oils, and sprays, to treat psoriasis of the scalp.
* Ointments, to treat psoriasis of the nails.
* some exposure to sunlight.

Ongoing treatment

Creams and ointments may be used in combination with sunlight or ultraviolet light (phototherapy) for moderate psoriasis that affects less than 20% of the skin surface (about equal to having both arms completely covered). However, creams, ointments, lotions, and topical (applied to the skin) medications work better for some people than for others. If one topical treatment does not clear up your psoriasis, your doctor will likely recommend that you try different combinations of treatments.

Treatment if the condition gets worse

If you have severe psoriasis, in which the rash, or plaque, covers more than 20% of your skin surface, your doctor may recommend systemic therapy. (Having both your arms completely covered with plaque is equivalent to 20% of your skin surface.) Systemic therapy involves the use of medications such as retinoids, methotrexate, and cyclosporine, usually in addition to continued topical treatments and exposure to ultraviolet light.

Some of the symptoms of Psoriasis are alos like yours, but its not sure about yours, so you need detailed examination.
You just try some ointments like PANDERM, CANDID B etc, so that you can recover from this little little itchng and patches. If not getting much change after that, better you go for more consultation.

Dr. Friend

Currently there is no cure for psoriasis. However, many types of treatment are available, including products applied to the skin, phototherapy, and oral medications, that can keep psoriasis under control. most cases are mild and can be treated with skin products. in some cases, psoriasis can be hard to treat if it is severe and widespread. most psoriasis returns, even mild forms.

The purpose of treatment is to slow the rapid growth of skin cells that causes psoriasis and to reduce inflammation. Treatment is based on the type of psoriasis you have, its location, its severity, and your age and overall health. It also depends on how much you are affected by the condition, either physically (because of factors such as joint pain) or emotionally (because of embarrassment or frustration from a skin rash that may cover a large or visible area of the body).

Initial treatment
Treatment for mild psoriasis, characterized by a few isolated raised patches, begins with skin care, which includes keeping your skin moist and lubricated. Basic treatment approaches often involve combinations of therapies and products that can usually be purchased without a prescription, including:

Creams, ointments, and lotions, to lubricate the skin.
Shampoos, oils, and sprays, to treat psoriasis of the scalp.
Ointments, to treat psoriasis of the nails.
Some exposure to sunlight.

Although we usually only consider Psoriasis a skin condition, it can also cause a specific form of arthritis, and involvement with the fingernails or nail beds. Treatment is dependent on the severity of the condition. some people benefit from sunlight or tanning beds (be careful not to burn) and topical creams or lotions. mine got better one time using a lotion with colloidal oatmeal (like Aveeda)

If it is more severe, consult a dermatologist. there are some very good new treatments including a new injection that has helped people that nothing else helped for years.

Homoeopathy and Naturopathy are the two methods to cure psoriasis. the combination of these two help curing it. But it may take a long time. Better avoid NV diet. Consume plenty of fresh vegetables like carrot, cabbage and spinach. Take lot of carrot juice esp. in empty stomach. Neem also helps curing psoriasis (Please see the link below).

Press Release Source: Novartis on Monday December 6, 2010, 7:09 am EST

EAST HANOVER, N.J., Dec. 6, 2010 /PRNewswire/ —

• Fewer patients taking Tasigna for Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase progressed to advanced stages of the disease

• 24-month analysis confirms Tasigna induces deeper and more durable cytogenetic and molecular responses

• Tasigna now approved in the US and Switzerland for this indication; regulatory submissions under review in EU, Japan and other countries worldwide

Novartis announced today 24-month data showing that Tasigna® (nilotinib) 150 mg capsules continues to surpass Gleevec® (imatinib mesylate) tablets* in the treatment of adult patients with newly diagnosed Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML) in chronic phase (1). These new data, from the first Phase III comparison of the two oral therapies as initial treatment for this blood cancer, were presented at the 52nd Annual Meeting and Exposition of the American Society of Hematology (ASH) in Orlando, Florida.

With this longer-term follow-up at 24 months, first-line treatment with Tasigna at 300 mg twice daily was found to result in a lower incidence of progression to accelerated phase and blast crisis, compared to the standard approved dose of Gleevec 400 mg once daily. Patients receiving Tasigna also had a lower incidence of suboptimal response and treatment failure as defined by study criteria (1).  

These data also showed that Tasigna induced deeper and more durable complete cytogenetic response (CCyR) and major molecular response (MMR) compared to Gleevec, as well as a significantly higher rate of an even deeper response – a trace amount of 0.0032% or less of the Bcr-Abl protein that causes Ph+ CML, which is considered a complete molecular response (CMR) (1). fewer patients taking Tasigna in the study discontinued treatment due to adverse events compared to Gleevec (1). Tasigna and Gleevec were generally well tolerated.

“These 24-month Phase III data extend the evidence of clinical benefit for newly diagnosed patients with chronic phase Ph+ CML treated with Tasigna, compared to Gleevec,” said Timothy P. Hughes, MD, ENESTnd study investigator and Clinical Professor at the University of Adelaide, Australia. “Now we can begin to evaluate the long-term treatment outcomes of patients who achieve and maintain deep reductions in Bcr-Abl on Tasigna.”

Rates of MMR and CCyR remain statistically higher for Tasigna versus Gleevec at the 24-month minimum follow-up. MMR was achieved by 71% of patients taking Tasigna 300 mg twice daily and 67% of patients taking Tasigna 400 mg twice daily, compared to 44% of patients taking Gleevec by 24 months. Durable MMR rates were statistically significantly higher in the Tasigna 300 mg twice daily and Tasigna 400 mg twice daily arms compared to Gleevec 400 mg once daily (42%, 39% and 21% respectively). Significantly more patients achieved CCyR in the Tasigna 300 mg and 400 mg arms compared to the Gleevec arm at 87% and 85% vs. 77% respectively by 24 months.

The US Food and Drug Administration (FDA) and Swissmedic have approved Tasigna in this first-line indication. in September, Novartis received a positive opinion from the Committee for Medicinal Products for Human use (CHMP) recommending European Commission approval for Tasigna for this indication. Regulatory submissions are under review in the European Union, Japan and other countries worldwide.

This year, Novartis also began a collaboration with molecular diagnostics company Cepheid to develop a new FDA cleared/approved Bcr-Abl test, which adheres to the International Scale. The goal of the collaboration is to help doctors more reliably monitor Ph+ CML patients. Cepheid and Novartis also will develop a next generation test, which is expected to enable even more sensitive testing, indicating the depth of a patient’s response to tyrosine kinase inhibitors, including Tasigna and Gleevec. currently there are no FDA cleared/approved tests to monitor for Bcr-Abl.

“The creation and introduction of Gleevec revolutionized the treatment of Ph+ CML by substantially improving overall survival rates for patients,” said Herve Hoppenot, President, Novartis Oncology. “We are encouraged by the ongoing clinical development of Tasigna as a new treatment showing that at 24 months it continues to surpass Gleevec in slowing disease progression in patients with newly diagnosed chronic phase Ph+ CML.”

Another study will be presented at this year’s annual ASH meeting which provides further support for the use of Tasigna in patients with newly diagnosed Ph+ CML. The Gruppo Italiano Malattie Ematologiche dell’Adulto (GIMEMA) study, an ongoing, open-label, single-stage, multicenter Phase II clinical trial, will be presented on Monday, December 6, 2010 (2).

ENESTnd Study Details

The clinical trial, ENESTnd (Evaluating Nilotinib Efficacy and Safety in Clinical Trials of Newly Diagnosed Ph+ CML Patients), is a Phase III randomized, open-label, multicenter trial comparing the efficacy and safety of Tasigna versus Gleevec in adult patients with newly diagnosed Ph+ CML in chronic phase (1). it is the largest global randomized comparison of two oral therapies ever conducted in newly diagnosed Ph+ CML patients.

ENESTnd is being conducted at 217 global sites with 846 patients enrolled. Patients were randomized to receive Tasigna 300 mg twice daily (n = 282), Tasigna 400 mg twice daily (n = 281) or Gleevec 400 mg once daily (n = 283). The primary endpoint was MMR at 12 months; the key secondary endpoint was durable MMR at 24 months (patients having MMR when evaluated at both 12 and 24 months) (1). MMR was defined in the study as reduction in the level of the abnormal Bcr-Abl gene to less than or equal to 0.1% of the pretreatment level based on an internationally agreed standard (1). Planned follow-up is for five years. Patients on the Gleevec treatment arm who had suboptimal response or treatment failure were allowed to escalate dose and/or switch to Tasigna via a protocol extension. These data, presented at ASH, were the 24-month minimum follow-up.

Results showed that fewer patients progressed to accelerated phase or blast crisis while on treatment with Tasigna at 300 mg twice daily (n = 2) and 400 mg twice daily (n = 3) versus Gleevec at 400 mg once daily (n = 12) (1) with 24 months of minimum follow-up demonstrating a significant improvement in disease control.

These data also showed that nearly three times more patients taking Tasigna 300 mg twice daily achieved CMR – defined as a trace amount of 0.0032% or less of the Bcr-Abl protein that causes Ph+ CML – with Tasigna 300 mg twice daily (n = 70) than with Gleevec (n = 25) by 24-months (1).

All patients had a minimum of 24 months of treatment or discontinued early; the median follow-up was 25 months. Overall, 75%, 78% and 68% of patients remained in the study on Tasigna 300 mg twice daily, Tasigna 400 mg twice daily and Gleevec 400 mg once daily, respectively (1).

Both Tasigna and Gleevec were generally well tolerated overall. Rates of discontinuation due to adverse events or laboratory abnormalities were 9% for Tasigna 300 mg twice daily, 13% for Tasigna 400 mg twice daily and 11% for Gleevec 400 mg once daily (1). No patients treated with Tasigna in the study had prolongation of QT interval >500 milliseconds (1). No sudden deaths occurred in any of the treatment arms (1).

About Philadelphia Chromosome-Positive Chronic Myeloid Leukemia (Ph+ CML)

Chronic myeloid leukemia is a disease in which the body produces cancerous white blood cells. Almost all patients with CML have an abnormality known as the Philadelphia chromosome, which produces a protein called Bcr-Abl. Bcr-Abl causes malignant white blood cells to proliferate (3). Worldwide, CML is responsible for approximately 10% to 15% of all adult cases of leukemia (4), with an incidence of one to two cases per 100,000 people per year (5).

About Tasigna (6)

Tasigna® (nilotinib) is indicated for the treatment of adult patients with newly diagnosed Philadelphia chromosome positive chronic myeloid leukemia (Ph+ CML) in chronic phase. The effectiveness of Tasigna is based on major molecular response and cytogenetic response rates. The study is ongoing and further data will be required to determine long-term outcome.

Tasigna is indicated for the treatment of chronic phase and accelerated phase Philadelphia chromosome positive chronic myelogenous leukemia (Ph+ CML) in adult patients resistant or intolerant to prior therapy that included imatinib. The effectiveness of Tasigna is based on hematologic and cytogenetic response rates. there are no controlled trials demonstrating a clinical benefit, such as improvement in disease-related symptoms or increased survival.

Tasigna has been approved in more than 85 countries for the treatment of chronic phase and accelerated phase Ph+ CML in adult patients resistant or intolerant to at least one prior therapy, including Gleevec. The effectiveness of Tasigna for this indication is based on hematologic and cytogenetic response rates. there are no controlled trials demonstrating a clinical benefit, such as improvement in disease-related symptoms or increased survival.

Tasigna important Safety Information

WARNING: QT PROLONGATION AND SUDDEN DEATHS

Tasigna prolongs the QT interval. Sudden deaths have been reported in patients receiving nilotinib. Tasigna should not be used in patients with hypokalemia, hypomagnesemia, or long QT syndrome. Hypokalemia or hypomagnesemia must be corrected prior to Tasigna administration and should be periodically monitored. Drugs known to prolong the QT interval and strong CYP3A4 inhibitors should be avoided. Patients should avoid food 2 hours before and 1 hour after taking dose. a dose reduction is recommended in patients with hepatic impairment. ECGs should be obtained to monitor the QTc at baseline, seven days after initiation, and periodically thereafter, as well as following any dose adjustments.

Contraindications

Do not use in patients with hypokalemia, hypomagnesemia, or long QT syndrome.

Warnings and Precautions

Myelosuppression

Treatment with Tasigna (nilotinib) can cause Grade 3/4 thrombocytopenia, neutropenia and anemia. Perform complete blood counts every two weeks for the first 2 months and then monthly thereafter, or as clinically indicated. Myelosuppression was generally reversible and usually managed by withholding Tasigna temporarily or dose reduction.

QT Prolongation

Tasigna prolongs the QT interval.  ECGs should be performed at baseline, seven days after initiation, periodically as clinically indicated, and following dose adjustments. Correct hypokalemia or hypomagnesemia prior to administration and monitor periodically.

Significant prolongation of the QT interval may occur when Tasigna is inappropriately taken with food, and/or strong CYP3A4 inhibitors and/or medicinal products with a known potential to prolong QT. therefore, co-administration with food must be avoided and concomitant use with strong CYP3A4 inhibitors and/or medicinal products with a known potential to prolong QT should be avoided. The presence of hypokalemia and hypomagnesemia may further enhance this effect.

Sudden Deaths

Sudden deaths have been reported in patients with resistant or intolerant Ph+ CML receiving nilotinib (n = 867; 0.6%). a similar incidence was also reported in the expanded access program for patients with resistance or intolerant Ph+CML. The relative early occurrence of some of these deaths relative to the initiation of nilotinib suggests the possibility that ventricular repolarization abnormalities may have contributed to their occurrence.

Elevated Serum Lipase

Caution is recommended in patients with a history of pancreatitis. in case lipase elevations are accompanied by abdominal symptoms, doses should be interrupted and appropriate diagnostics should be considered to exclude pancreatitis. Check serum lipase levels monthly or as clinically indicated.

Hepatotoxicity

Serum bilirubin and hepatic transaminases

The use of Tasigna may result in elevations in bilirubin, AST/ALT, and alkaline phosphatase. Hepatic function tests should be checked monthly or as clinically indicated.

Electrolyte Abnormalities

Tasigna can cause hypophosphatemia, hypokalemia, hyperkalemia, hypocalcemia, and hyponatremia. Correct electrolyte abnormalities prior to initiating Tasigna and monitor periodically during therapy.

Hepatic Impairment

Nilotinib exposure is increased in patients with impaired hepatic function. a lower starting dose is recommended for patients with mild to severe hepatic impairment and QT interval should be monitored closely.

Drug Interactions

The concomitant use of QT prolonging drugs and strong inhibitors or inducers of CYP3A4 should be avoided as they may affect serum concentration of Tasigna.

Concomitant strong CYP3A4 inhibitors

The concomitant use of strong CYP3A4 inhibitors or anti-arrhythmic drugs (including, but not limited to amiodarone, disopyramide, procainamide, quinidine and sotalol) and other drugs that may prolong QT interval (including, but not limited to chloroquine, clarithromycin, haloperidol, methadone, moxifloxacin, and pimozide) should be avoided. should treatment with any of these agents be required, it is recommended that therapy with Tasigna be interrupted. If interruption of treatment with Tasigna is not possible, patients who require treatment with a drug that prolongs QT or strongly inhibits CYP3A4 should be closely monitored for prolongation of the QT interval. If patients must be co-administered a strong CYP3A4 inhibitor, based on pharmacokinetic studies, consider a dose reduction to 300 mg once daily in patients with resistant or intolerant Ph+ CML or to 200 mg once daily in patients with newly diagnosed Ph+ CML-CP. If the strong inhibitor is discontinued, a washout period should be allowed before Tasigna is adjusted upward to the indicated dose. Close monitoring for prolongation of the QT interval is indicated for patients who cannot avoid strong CYP3A4 inhibitors. Grapefruit products and other foods that are known to inhibit CYP3A4 should also be avoided.

Concomitant strong CYP3A4 inducers

The concomitant use of strong CYP3A4 inducers should be avoided (including, but not limited to, dexamethasone, phenytoin, carbamazepine, rifampin, rifabutin, rifapentin, phenobarbital). Patients should also refrain from taking St John’s Wort.   Based on the nonlinear pharmacokinetic profile of nilotinib, increasing the dose of Tasigna when co-administered with such agents is unlikely to compensate for the loss of exposure. Tasigna is a competitive inhibitor of CYP3A4, CYP2C8, CYP2C9, CYP2D6, and UGT1A1. in vitro studies also suggest that nilotinib may induce CYP2B6, CYP2C8 and CYP2C9, and decrease the concentrations of drugs which are eliminated by these enzymes. Single-dose administration of Tasigna to healthy subjects did not change the pharmacokinetics and pharmacodynamics of warfarin (a CYP2C9 substrate). The ability of Tasigna to induce metabolism has not been determined in vivo. Caution should be exercised when co-administering Tasigna with substrates for these enzymes that have a narrow therapeutic index. Tasigna inhibits human P-glycoprotein. If Tasigna is administered with drugs that are substrates of Pgp, increased concentrations of the substrate are likely and caution should be exercised.

Proton pump inhibitors

Since proton pump inhibitors affect pH of the upper GI tract for an extended period, separation of doses may not eliminate the interaction, The concomitant use of proton pump inhibitors with Tasigna should be used with caution.

Food Effects

Food increases blood levels of Tasigna. Patients should avoid food  2 hours before and at least one hour after the dose is taken.

Total Gastrectomy

The exposure of nilotinib is reduced in patients with total gastrectomy.  More frequent follow-up of these patients should be considered. Dose increase or alternative therapy may be considered in patients with total gastrectomy.  

Lactose

Since the capsules contain lactose, Tasigna is not recommended for patients with rare hereditary problems of galactose intolerance, severe lactose deficiency with a severe degree of intolerance to lactose-containing products, or of glucose-galactose malabsorption.

Use in Pregnancy

There are no adequate and well-controlled studies of Tasigna in pregnant women.  However, Tasigna may cause fetal harm when administered to a pregnant woman. Women of child-bearing potential should avoid becoming pregnant while taking Tasigna and should be advised of the potential hazard to the fetus if they do.

Adverse Reactions

Newly Diagnosed Ph+ CML-CP:

The most common (>10%) non-hematologic Adverse Drug Reactions (ADRs) were rash , pruritus , headache, nausea, fatigue, and myalgia . Upper abdominal pain, alopecia, constipation, diarrhea, dry skin, muscle spasms, arthralgia, abdominal pain,  peripheral edema, and asthenia were observed less commonly (5%) and have been mild to moderate severity, manageable, and generally did not require dose reduction. Pleural and pericardial effusions occurred in 1% of patients. Gastrointestinal hemorrhage was reported in 0.4% of patients.